Wednesday, May 12, 2010

Subsidy and Other Preoccupations 21

WE ARE doctors specialising in various fields at Gleneagles Medical Centre and we support Dr Lee Wei Ling's gallant attempts to bring medicine in Singapore back to its noble roots ('Train GPs to be family physicians'; April 21).

We suggest the following:

- Invasive aesthetic procedures should be carried out only by doctors who have had adequate surgical training. Only then will the practitioner be able to recognise the early signs of complications. Complications happen even in the best surgeon's hands, but it is often how soon these are detected and the course of action taken that determine the fate of the patient. Aesthetic medicine is here to stay and the Ministry of Health (MOH) should organise properly sanctioned courses for all doctors who are keen to carry out invasive aesthetic procedures. The bar must not be set too low, and being allowed to carry out such dangerous procedures after attending dubious one- to two-day courses should be a thing of the past.

- General practitioners (GPs) are the vanguards of our health-care system. We want each GP to take his proper place as a 'specialist in taking care of the entire patient'. All of them have undergone training at great expense to the state or their families. MOH should make available rotation positions at various hospital departments for all GPs before they start work and at regular intervals after that, to provide opportunities for 'refreshers' to those who feel they need updates or have gaps in their knowledge of certain specialities. National service 'reservist-style' make-up pay is innovative and workable for this.

- Government subventions for GPs to treat subsidised cases is a win-win for all. GPs get more income and hence will be less likely to go for the more lucrative 'aesthetic medicine' route, and the already overcrowded polyclinics will be able to perform even better. In the same vein, many private specialists are also keen to help by treating subsidised patients who are presently referred to overcrowded specialist clinics at public hospitals.

The medical profession should do regular soul-searching, and if we find that we have deviated from our intended paths, we should have the courage to take remedial actions to rectify this.

Dr Huang Shoou Chyuanangry doc thinks Dr Huang has correctly identified why many GPs are doing aesthetic medicine - it pays better.However, angry doc doesn't think that more training is what is required, or that having the government to put more money into subsidising healthcare is a fair thing to do, or that it will reduce the number of GPs doing aesthetic medicine or the number of complications arising from it.GPs don't go into aesthetic medicine because they don't know how to be "a 'specialist in taking care of the entire patient' "; many already possess post-graduate degrees or diplomas in family medicine, and regardless of whether they do or do not all of them are required to attend a minimum number of hours of Continual Medical Education every two years. The learning opportunities and resources are there, and those who want to be better at their craft will utilise them, while those who do not will perhaps just sign the attendance form and take advantage of the free lunch and check their email on their iPhones while the speaker drones on; you can force doctors to attend training, but you cannot force them to learn, or to practise what they been taught in their daily practice.Doctors will learn when they perceive that it is to their advantage to do so, and GPs who practise aesthetic medicine regularly take time off their practice to learn about new techniques and new equipment. They don't need MOH to pay them for their time, do they?Will making the government pay GPs for seeing non-aesthetic cases work?angry doc thinks it may make GPs give up aesthetic medicine and return to family medicine if (and it's a big and important 'if') the trade-off seems favourable to the GP, and that means that at the end of the day the GP should still make as much if not more money than if he did aesthetic medicine. However, the cost involved makes it unlikely that our Health Minister will likely propose that.And even if we do subsidise patients who visit a GP for non-aesthetic problems, patients will still visit GPs for aesthetic procedures (they have been doing so, and won't have any reason to stop now), and GPs who have been doing aesthetic medicine will still do aesthetic medicine (again, they have been doing so and won't have any reason to stop now either). In fact, angry doc may even argue that with part of the cost of their non-aesthetic medicine paid for by the government, patients will now have more money to spend on aesthetic medicine. OK, maybe with more money to spare now they will visit a specialist for their aesthetics needs and not a GP.angry doc thinks that the 'problem' of GPs doing aesthetic medicine is really a reflection of how doctors and patients prioritise their wants and resources. Trying to reverse the trend by asking people to be 'noble' isn't going to work, and throwing more tax money at it isn't always a solution; if good primary care is so important that we can consider forcing doctors to provide them, then why shouldn't we require that those who benefit from it take personal responsibility and pay for it?

There is a way to solve this problem. And the Ministry looks like they are starting to get it going.

Here's the gist of it

1) Market works on supply and demand.

2) Flood the market with supply ie more doctors. Increase intake. Increase foreign doctors. Train all of them to be specialists too.

3) Increased supply will eventually catch up. You have higher doctors per patients ratio. Naturally the cost to see a doctor will stagnate or even drop.

4) More GPs go into aesthetics. See point 1 and start from there again.

It will take time for us to see the results but it will come. The only challenge that Ministry has to overcome is to continue to make medicine attractive to young intelligent students so that we can have good candidates to take up medicine (some would say dupe them). Also to continue to make Singapore attractive to foreign doctors to come here to work.

Ironically I think the smart ones are already staying away from medicine for the reasons pointed out above.

Last resort is rather simple. Nationalize the health care system. Start first with primary care. No more private GP clinics. All come under government control. You can have "semi-private" class stratified clinics run by govt but not by private individuals. Then slowly work your way into the specialist sector also. But you still need to work on flooding the supply to hurt the earnings of doctors first.

You will, Anon; but then by then "the smart ones are already staying away from medicine", so you end up with a healthcare system where the smartest don't enter, and those who do are paid poorly, and only those who aren't competent enough to find employment elsewhere remain in the system.

Anon has a point. When was the last time you saw a doctor who was attacked actually defend himself/herself? It's almost like an unspoken rule that if anyone attacks a doctor, well the doctor is to turn the other cheek. What are doctors going to do if we just forcefully cut their pay in half? All quit? Mass resign? Strike? I really doubt they have the guts to do that.

1. It seems like many anon people here think that healthcare should be cheap or even free in Singapore. I guess let's make it "free" - just like the UK. All the anons would only need to pay 40% taxes and a national insurance contribution. Be careful what you wish for, anons!2. Same old story about the brightest going into medicine to save people and live as paupers. The government has already made it clear that if you want the best people to serve you, you need to pay top dollar. Still confused? Ask your MP to explain why he deserves more than 200k a year.

@Anon on 24th May,I would like to say specialised surgeons are the tip of the iceberg. Most doctors barely hit 13k with bonuses, esp those in primary care. (Of whom you think should be paid pittance)

I'll also like to say it's not always as clear as black and white. AngryDoc points are as valid as those asking for more subsidies.

However, sometimes i don't understand why people view healthcare they way the see it.

If you want to invest your money with an investment banker, would you pay more for a good one to guarantee returns or would you go for someone who charges you 10 bucks but almost guarantees losses???

Similarly, if you are charged with a crime you did not commit and were innocent, would you go for a pro-bono half-assed lawyer or spend your entire fortune on the top dog??

You might say all these scenarios are different, which in fact there are. But the unifying issue is the value you perceive the issue to be. You pay for good service/good quality.

Subsidy is not the answer to everything. Both camps, Angrydoc and Anons have valid arguements......personally i haven't found a balance to this yet but i know that subsidizing everything is definitely NOT the answer.... unless you wish for communism in SG.

if overheads like rental are so so high, if doctors are not concern about money how to survive.

but how come rental are so high?

this is all the government fault.

government should control rental from getting higher and higher.

if rental for all businesses, no matter it is GP, dentist, the recent open private hawker centre in sengkang, tuition centres, bookshops, optical shop, resturant......all can sell cheaper and can be much more humane, then it will surely benefit all singaporean.

please government, please control the rental 1 beg you.

it is the root of all problems.

its all about money money and more money they just want more and more money.

government and hdb is not like a private company eg capitaland.

some more capitaland link to Temasek and Temasek link back to?? everyone knows.

if singapore rental all reduce, maybe government no need to give so much subsidy people still can afford to see private doctors as private docotrs gp and specialists will charge cheaper due to lower rental. then polyclinic and governmant hospital will also not be too crowded.

I think lowering rentals is not the solution.Lowering rentals would reduce the value of properties, resulting in many owners losing money, banks having bad debts.

The solution is to increase subsidies to the poor and needy and also to make subsidies portable so that they can be used for the poor and needy to seek help from gps, polyclinics or SOCs.

Poor and needy patients can then choose to see which doctors they want to see.This is a win win situation as the patients are happy, lower waiting time and better serviceGps are happy as more patients see themPolyclinics are happy as less crowdedSocs are happy as less crowded.

The problem is how to fund the increase in the subsidies. I suggest to increase income taxes for the rich to fund this increase in medical subsidies.

"I think lowering rentals is not the solution.Lowering rentals would reduce the value of properties, resulting in many owners losing money, banks having bad debts"

actually the root of the problem is started by government. they jack up price of everything like hdb flats example...

"reduce the value of properties, resulting in many owners losing money, banks having bad debts"this will be very painful for all singaporeans to face, but if prices of everything keep on going higher higher and higher, i guess the pain we suffer will be even even even more than the pain of reducing value of properties, resulting in many owners losing money, banks having bad debts.

like what currently the usa is facing, the housing crisis, yes it is very painful now but if lets say 5 or 10 years later then the crisis start instead of 2008, the pain and damage will be even even worse.

the root of problem is government. if minister is getting extremely high pay millions in dollars, this will have a ripple effect in everything else...all other things price will increase.

how will the rich want to pay more taxes when people in public service like ministers are getting millions in pay.

actually this is back to government minister should not be getting millions in pay. they are doing public service they chose to help singaporeans like dr goh keng swee he done so much how much pay has he gotten? anyone knows?

if let say minister are doing so much things for singapore to help singapore and they are only getting a normal pay, then if taxes for rich are increase they will be willing to pay as well. because they can see minister are setting the right example. if ministers are getting millions in pay which is the root of all problems and setting bad examples, the rich where will want to help the poor by paying more taxes as minister are getting much more.

or there should be a new tax law like the taxes for all ministers will be 50% and for rich people then we can say their tax should increase more as well but not to 50% that is for ministers only, since the ministers are already setting example, so the rich should follow as well.

if not we should vote for a political party where if they become governemnt, their ministers will not get millions in pay.

but in real life cases i am not sure in actual fact how many people will feel this way.

due to the fact that they are so many external factors. and governemnt is the root of all factors.

singaporeans are very good and lawfully people. so whatever the government do people will follow (or you can say no choice). so if lets say minister get low pay, to help singaporeans, and taxes increase to help poor people, rich people will not complain( or you can say no choice), if now ministers get millions in pay, they have no reason to ask rich to pay higher taxes.

minister must set example and singaporeans will follow.

to help more people.

but all this is a look from the humane, kind, caring part of view.

like what all doctors should be.

but in real life cases i am not sure in actual fact how many people will feel this way.

"I am not rich, but I refute any man's claim that the poor have a right to the rich's money just because they are poor"

Angry dr is not just uncaring but selfish.The rich should pay back to society what they have gotten from society.Look at Yong Loo Lin who build NUS medical school, Tan Tock Seng who build TTSH, KTP who build KTP hospital.

So you are saying that they should not donate money to help the poor and needy. I definitely don't want you to be my doctor. I am sure you charge full rates for all your patients whether they are rich and poor.

There are things in life that are more important than money.I wonder how you became a doctor with the mercenary mindset :(

Well rich people are not obliged to give money to the poor. It is a matter of how you understand the action. You should stop for a little while and analyze the situation.... Would it make you feel complete or satisfied to buy stuff you don't even need or to eat food even though you're full? Is satisfaction achieved whenever you waste money and saw a family starving for food? You are blessed with money and comfort, don't you think you need to share it with the less fortunate? We also owe them something, because as you can see we are a product of the improving technology, we contribute to the improving technology as we buy their gadgets or clothing and etc., because many people like to have these things the demand increases, and as the demand increased the supply is also increased. And of course these can't be produced without the resources, resources that were plenty and free before but now became less and in demand to the extent that people bid prices or money for it. We can see poor people along the road because we lack resources which we need everyday. As what you know people before don't have money, sharing and giving were peacefully followed and done. We are the reasons why there is starvation. Now that everything's too late and people are already lured to the 'cool stuffs' we should help one another because to change things where it was before is a very hard and a very impossible thing to do. We are all one and you should understand that, we have the same needs to look up to everyday, the only difference is the name of the country we are staying in. The looks are normal there are really a difference in that part, come to think of it who would want or like to see people looking just like theirselves? How would you recognize one from the other if we all have the same face? Now, back to the beginning, are you happy whenever you see people suffering from the things deprived from them? Will the saying 'regret comes after' become popular to the rich when many had died or risked their lives just to look for money? If these emotional questions won't affect you here are some tough one; what if a man knocked on the windows of your car asking for some food and you just ignored him, then suddenly one day a terrible news arrived, that tells a man kidnapped a close relative of yours, the same man as the one who knocked on your windows did the crime, would it be scary to think of what things he might do to your relative? Or here's another situation that man who knocked on your car's window was reported the next day as dead, he committed suicide because of the unfair or problematic world he is living in, will that affect you? Does this prove regret comes after? In the Philippine's currency 1.00 is important because that one peso creates or is in a million. Remember that simple things create a big difference. This is the part where I need to end my 'supposed' answer here's another quote or saying for you to think about, just relate the power with money, 'With great power comes great responsibility', thank you for your time and you take care.

Just because I reject the notion that the rich should be forced to give to the poor doesn't mean that I:

- feel complete or satisfied to buy stuff I don't even need or to eat food even though I'm full.

- achieve satisfaction whenever I waste money and see a family starving.

Just because I don't think other people are entitled to my money doesn't mean that I waste them or that I don't give - I give when I want, not when you tell me to, because it's my money and not yours. Learn that there is a difference, and learn to respect that.

"We also owe them something, because as you can see we are a product of the improving technology..."

I have no idea what you are talking about there.

"As what you know people before don't have money, sharing and giving were peacefully followed and done."

I don't think that is a fact. Can you substantiate your claim?

"We are the reasons why there is starvation."

The reason for large-scale starvation is complex, and if you think by getting rid of the rich you will create a better society, you might want to learn a thing or two about French, Russian and Chinese history.

"How would you recognize one from the other if we all have the same face?"

You've lost me there again. Do you actually read what you write?

"...are you happy whenever you see people suffering from the things deprived from them?"

Suffice to say that I do not feel guilty.

"... what if a man knocked on the windows of your car asking for some food and you just ignored him, then suddenly one day a terrible news arrived, that tells a man kidnapped a close relative of yours, the same man as the one who knocked on your windows did the crime, would it be scary to think of what things he might do to your relative?"

So that's the reason why the rich should give to the poor? Fear that the poor may harm them? If that's the kind of thinking you have, what distinguishes you from a robber? At least a robber is more honest - he does not hide behind a facade of morality to demand things from you.

"Or here's another situation that man who knocked on your car's window was reported the next day as dead, he committed suicide because of the unfair or problematic world he is living in, will that affect you?"

Again, suicide is a complex matter and if you think some food is going stop a man from killing himself you... how old are you exactly anyway?

No, I will not feel guilty.

"In the Philippine's currency 1.00 is important because that one peso creates or is in a million."

Huh?

I don't know how you got so entrenched in the idea that the rich are evil and the cause of poverty and starvation in the world, and that the only way they can redeem themselves is to give to the poor. But that's a very simplistic and erroneous way of looking at the world. Do yourself a favour: find a responsible adult (or a few), share your views with him or her, and ask him or her if he or she agrees.

You write like elite gal.Blaming the poor and refusing to help them even though u can afford too.Asking the poor and need to get out of your elite uncaring face.

But u are a doctor and u should have some compassion to help the poor and needy. If the rich has to pay more so as to help the poor and needy, let them be taxed more. What is wrong with it?$1000 may be small change to the rich but it can mean life and death to the poor and needy!

"Are you a rich person? Will you be willing to pay more taxes if ministers are getting "normal" pay? How many other of your rich friends have you polled for you to arrive at your conclusion?

I am not rich, but I refute any man's claim that the poor have a right to the rich's money just because they are poor."

Angry doc what I am feeling strange or unique about is you are not rich but you still "stand" on the rich side.

I am not rich as well like you and i "stand" on the poor side. so this may not be fair for me to make a good comment. actually i can agree with you.

thats why you ask me to poll people. the people i met are not rich as well so they usually "stand" on my side as well. so the opposite should be true as well. if let say i am rich person i will most likely "stand" on the rich side, do not want to pay more taxes and all the people i know and poll are rich as well so they will "stand" on the rich side as well like me.

but for you, you are different. even if you are not rich you do not "stand" on the poor side, instead you "stand" on the rich side. so this means that even if you are a begger you will not feel you become a begger due to the reason that rich people are the reason why that cause you to be one and not blame rich people for not helping you. am i right?

instead you will try your very very best to improve your life and not be a begger anymore? am i right?

if this is so this is a very correct attitude. i agree with you.

but i am just not happy that minister are getting millions in pay which is too high as what they are doind is no justifiable for such high pay. and in order for them to get high pay, cost of everything in singapore will increase and in the end of the day surely cost of healthcare will incrase as well.

if any minister can solve the problem we are talking about them 5miilion in salary for him should be ok as well. but can pm or mr khaw do it??

"even if you are a begger you will not feel you become a begger due to the reason that rich people are the reason why that cause you to be one and not blame rich people for not helping you. am i right?"

Correct. I will not beg, and I most certainly will not beg with the expectation that it is my right to receive.

"instead you will try your very very best to improve your life and not be a begger anymore? am i right?"

Yes. Wouldn't you?

"in order for them to get high pay, cost of everything in singapore will increase and in the end of the day surely cost of healthcare will incrase as well."

I don't think that is true. Do you seriously think that if all the ministers halved their pay then the cost of everything in Singapore will come down? Seriously?

"if any minister can solve the problem we are talking about them 5miilion in salary for him should be ok as well. but can pm or mr khaw do it??"

What problem exactly are you talking about?

"what I am feeling strange or unique about is you are not rich but you still "stand" on the rich side."

"but for you, you are different. even if you are not rich you do not "stand" on the poor side, instead you "stand" on the rich side."

It's not about standing on the rich or poor side, but about respecting the fact that people have a right to keep what they have earned.

Let me give you an example.

Imagine you are a parent and one day your child comes home from the first day of school and tells you that in order to make the school a fairer place, the teachers have decided to redistribute test scores - the top 20% of students will have their scores deducted by 20%, and the bottom 20% will receive 20% more. The next 20% will have 10% deducted and added respectively. This will result in a more equal school.

"Teacher asked would anyone want to give one mark so the poor student can graduate."

The context here is not the top student being "asked" to help the 49% student, but being "told" to do so. We are not "asked" whether or not we want to pay taxes - we are "told" to do so.

I am not sure whom I despise most in your scenario though: the teacher who asked, the 49% student who will receive even though he had not earned the grade, or the 91% student who thinks that allowing someone who had not earned the grade to pass is the right thing to do.

And what if there are 5 students with 91% and 25 students with 49% or lower score?

What about the students with 48%? 47%?

Or one student with 51% and two with 48%? Should they all share and share alike so we have 3 students with 49%?

"Are u happy now that the rich are not willing to give what they dont need to people who need it to survive????"

You will only be unhappy if you begin with a sense of entitlement to the possessions of the rich. If you understand that the rich have the right to how they want to use their possessions, the same right as the rest of us, then you will accept that you have no right to be unhappy with them. You need to ask yourself: are I unhappy for the poor, in which case I can just help them myself, or am I unhappy with the rich for being richer than I am?

At the end of the day, it's not really about the rich or the poor, but about you.

"Correct. I will not beg, and I most certainly will not beg with the expectation that it is my right to receive."

you are a person with fair and justice i should say.

but lets say minister now is getting 10 million from next month onwards.

now their pay is 3 million we may still consider fair and reasonable.

10 million should not be fair and justice right? will you oppose this if minister get 10 million? or you will feel it is their right to get as they are minister what? will you help by voting a bad minister out? or voting a government out if you feel they are not good? or will you join them instead?

maybe its like if healthcare also becomes very very expensive for people. will you try to help them a little if they have no money to pay? or you will still feel it is their fault for not taking care of themselves and feel it is their fault for not trying their best to get out from provety? like mentioned earlier these people serve them right. they did not try their very very best to improve their life and not be a begger anymore.

lets say why hdb prices is so high now and how come minister mah is getting such a high pay.

is there a link in terms of minister is getting million in salary because he has done a good job. let say minister mah able to make hdb flat price to rise and rise due to lack in supply, so government earn more and more money and his pay get higher and higher.

will this apply to minister khaw? if healthcare get more and more expensive, government earn more and more so his pay can get higher and higher.

MOH spent a lot of money to subsidise the poor and needy.They have difficulty raising taxes because of people like angrydr who dont think the rich has a moral right to contribute to help those less fortunate.

If prices rise, it is because of greedy doctors threatening to quit if there are no pay rises.

"MOH spent a lot of money to subsidise the poor and needy.They have difficulty raising taxes because of people like angrydr who dont think the rich has a moral right to contribute to help those less fortunate."

Hi, Anon 7:50 PMyou means health care increase is due to greedy doctors, as government has actually help people a lot not really government fault?

i not really can agree totally. surely doctor cannot be too greedy as well, as doctors should help people. but lets say this doctor need to pay for a very expensive hdb flat to live in and cost of everything increase i think surely he has no choice but to hope for, lets not say ask for, a higher pay.

and just a curious question not sure if true or not or any link.

let say minister mah help government to make a lot of money from selling hdb flats at very high price, so the profit will help to pay for his pay and minister khaw pay and to subsidy healthcare as well.

if this is true then actually most singaporeans are doing good deed as we pay for expensive flats and the profis actually can help a lot of people. if this is true i am willingly to do so, or you can say if this is true even if it is like us helping ourselves it is still ok, as we pay a high price for flat and the profit earn will help to subsidy our own healthcare, i can accept. but if the profits is use to pay extremely high pay for ministers then i think not so good.

so lets say our ministers take lesser pay and this will lead to even more profits to be use to subsidy healthcare, and also can have more money to pay the doctors as doctors also need to use money to pay for their expensive hdb flat.

but maybe angry doctor is not say not a good and kind doctor, it is just that he also has no choice, force to have to fight for money as like most singaporean need to have more money to pay for expensive hdb flats as well, and expensive hdb flat is just 1 things, there are other things as well.

maybe lets say minister can get smaller pay and governement can have more others ways to save more money, like last time minister Dr Goh Keng Swee he is very thrify person and save a lot for government, then surely government will have more money and all these more money can be use to subsidy healthcare and some more no need to increase taxes to too high for poor or rich as well.

MOST those who care for the poor and needy are helping the poor and needy, and helping themselves as well.

from the high price we pay for hdb flats and many other things and most people live in hdb as well

most singaporeans are doing good deed as we pay for expensive flats and the profis actually can help a lot of people. it is like us helping ourselves as well, as we pay a high price for flat and the profit earn will help to subsidy our own healthcare.

so... is it like, our personal tax not so high in singapore as compare to australia which is 40%, but we pay high price for other things to compensate??

i want a health minister or other ministers who will lead by example to take a lower pay.

Dr Lee Wei Ling belongs to the old school of doctors where they regard patients before themselves.These doctors are willing to stay back in hospitals late to help their patients.However newer generation of doctors are becoming more self centered and are demanding to be paid overtime and demand to leave on time from hospitals. This mean we have to spend more money on them resulting in higher medical costs. If doctors can be less self centred and willing to stay behind to help out those on call, then working conditions will be better and it will be easier for us to recruit foreign doctors :)

A lot of foreign recruits dislike night calls because they r overwhemled by the work.If everybody stays behind to help out, then work load on call will be less and better working conditions for those on call.

I think it is pointless talking to you.Currently those on call are suffering and we are suggesting how to reduce workload on call but you seem to be concerned only on what is in it for you.If this is not called self-centred and selfish, I wonder what is?

I have been practising medicine for 30 years now. Over this period, medical science has advanced tremendously, but the values held by the medical community seem to have changed for the worse.

Yearning and working for money is more widely and openly practised; and sometimes this is perceived as acceptable behaviour, though our moral instinct tells us otherwise.

Most normal humans have a moral instinct that can clearly distinguish between right and wrong. But we are more likely to excuse our own wrongdoing if there are others who are doing the same and getting away with it.

These doctors who profit unfairly from their patients know they are doing wrong. But if A, B and C are doing wrong – and X, Y and Z too – then I need not be ashamed of doing the same. Medical students who see this behaviour being tacitly condoned will tend to lower their own moral standards. Instead of putting patients’ welfare first, they will enrich themselves first.

The most important trait a doctor needs is empathy. If we can feel our patient’s pain and suffering, we would certainly do our best by our patients and their welfare would override everything else.

Medicine is not just a prestigious, profitable career – it is a calling. Being a doctor will guarantee almost anyone a decent standard of living. How much money we need for a decent standard of living varies from individual to individual.

My needs are simple and I live a spartan life. I choose to practise in the public sector because I want to serve all patients without needing to consider whether they can pay my fees.

I try not to judge others who demand an expensive lifestyle and treat patients mainly as a source of income. But when the greed is too overwhelming, I cannot help but point out that such behaviour is unethical.

The biggest challenge facing medicine in Singapore today is the struggle between two incentives that drive doctors in opposite directions: the humanitarian, ethical, compassionate drive to do the best by all patients versus the cold, calculating attitude that seeks to profit from as many patients as possible. Hopefully, the first will triumph.

Doctors do have families to support. Needing and wanting money is not wrong. But doctors must never allow greed to determine their actions.

I think if a fair system of pricing medical fees – such that doctors can earn what they deserve but not profit too much from patients – can be implemented, this problem will be much reduced. The Guideline of Fees, which previously was in effect, was dropped last year. I am trying to revive it as soon as possible.

"I think if a fair system of pricing medical fees – such that doctors can earn what they deserve but not profit too much from patients – can be implemented, this problem will be much reduced. The Guideline of Fees, which previously was in effect, was dropped last year. I am trying to revive it as soon as possible."

well said your whole article doctor i saulte you.

as we can see again it is the government fault again. why they want to remove "The Guideline of Fees"??????

by removing it they are telling doctors money is the most important. and this will cause doctors like angry doctors no choice as well but to fight for money.

back to the root again. pm and minsters are getting millions in pay. they are doing public service not running a business like capitaland. if pm and ministers is getting millions in salary, how can they cap doctors fees by not leading good example? so if they cannot cap doctors fees, they have to remove "The Guideline of Fees" and this cause more doctors to feel it is the "right thing" to do, to earn as much as possible and same as what you said

"These doctors who profit unfairly from their patients know they are doing wrong. But if A, B and C are doing wrong – and X, Y and Z too – then I need not be ashamed of doing the same. Medical students who see this behaviour being tacitly condoned will tend to lower their own moral standards. Instead of putting patients’ welfare first, they will enrich themselves first."

but lucky in singapore we still have people like you and doctor lee wei ling who is different from his brother pm lee.

the root of the problem have to solve.

if lee wei ling becomes pm i guess most singaporeans will suffer much lesser.

please come out to stand for election dr lee wei ling and doctors like you.

so if minster cannot cap their own salaries, how can they cap doctors fees. they have to remove "The Guideline of Fees" and this cause more doctors to feel it is the "right thing" to do, to earn as much as possible and same as what you said and this cause people who want to be politicans think the same as well, not morals and public services most important but money and money.

so i guess they will still remove the docotors fees guidelines only if one day ministers can take lower pay then they will put back the docotors fees guidelines.

I don't regret becoming a doctor - it's something I am rather good at and I enjoy the continual process of learning involved.

I also do not feel ashamed of earning what I deserve. My skills are useful and I am not guilty to charge what they are worth.

As a member of the profession I reject the traditional role of the doctor as someone who must serve society above his own interests placed upon us by the public and our predecessors - I believe we should deal with our patients the same way as we deal with other people in society: as equals, giving something of value in return for something of value, not demanding another person's goodwill as a right.

As a tax-payer and an insider I resent the amount of wastage in the form of abuse seen in the subsidised healthcare system. I believe the subsidised healthcare in its current form must fail.

I believe we should take pride in our knowledge, and not mistake false humility as wisdom.

Well, if money is so unimportant to her and you, why are you still holding on to yours?

I'll answer you with this quote:

"To love money is to know and love the fact that money is the creation of the best power within you, and your passkey to trade your effort for the effort of the best among men. It's the person who would sell his soul for a nickel, who is loudest in proclaiming his hatred of money -and he has good reason to hate it. The lovers of money are willing to work for it. They know they are able to deserve it."

Bill Gates and Warren Buffett think fellow US billionaires should donate most of their vast fortunes to charity -- and they revealed Wednesday that 40 are set to do just that.

"Forty of the wealthiest families and individuals in the United States have committed to returning the majority of their wealth to charitable causes," said a statement released by www.givingpledge.org.

As of Wednesday, the group includes CNN founder Ted Turner, New York Mayor Michael Bloomberg, Oracle co-founder Larry Ellison and Hollywood director George Lucas, as well as Buffett and Gates.

"We probably called somewhere between 70 and 80 people on the Forbes list. It was a very soft sell, but 40 signed up," the chief executive of investment firm Berkshire Hathaway told reporters in a conference call. "We've made a terrific start."

The idea is to squeeze morally-, not legally-binding pledges from the super wealthy.

There'll be no group decisions on how money is spent or when. Instead, club members are to set an example by funding philanthropic pet projects, such as health, education and arts -- and preferably sooner rather later.

Almost all on the list are self-made, such as Bloomberg, and are worth about a billion dollars, or far more. A few represent longer-established fortunes, including David Rockefeller.

They are not talking about taking vows of poverty. Bloomberg said he would ensure that his children were never destitute.

But he still has more than he can ever need. "You can't spend it if you have over a certain amount," he explained.

US billionaires have been out of favor with the public and politicians since the 2008 financial collapse. The pledge scheme might burnish their image.

"Business people are pretty widely mistrusted and seen as overwhelmingly self-interested," conceded investment banker and newly signed-up pledge member Tom Steyer during the conference call.

"Warren and Bill Gates' point is an emphatically different one."

Apart from good PR, the scheme raises the prospect of eye-popping amounts of money flowing to charity.

If Gates and Buffett secured pledges of half the wealth of the 400 richest in the country, that would total more than 600 billion dollars, according to Forbes magazine estimates.

Gates alone is the second richest man in the world according to Forbes, with some 53 billion dollars, which places him narrowly behind Mexican telecoms tycoon Carlos Slim, with 53.5 billion.

Buffett, the second richest American, already announced in 2006 that he wanted gradually to give away all of his fortune estimated by Forbes at 47 billion dollars.

Rumors of the unprecedented drive first leaked in May 2009 when it emerged that Gates and Buffett had organized a secretive dinner for billionaires in New York City.

Wednesday's list featured some notable absences, including investor George Soros.

Buffett said that many had not been called yet and that others were simply unavailable. He would not say who had refused.

"I won't name any specific names," he said, adding that he expected the project to grow over the next year.

"You know, we don't give up on them. Every saint has a past, every sinner has a future."

Actually we can see from the above article at least about 50% of rich people will help the poor. so if taxes on rich increase on rich, at least 50% will agree.

and some more angry doctor i think you should read this:

"You know, we don't give up on them. Every saint has a past, every sinner has a future."